Sorting Out My Hormonal/Menstrually Associated Migraines

As the frequency of my migraine episodes has reduced this year, I was finally able to tell that I always get a migraine the first and second or third day of my period. Today once again provided confirmation.

Other treatment options exist. Most of them I’ve already taken without success. Magnesium, which I think is responsible for decreasing the frequency of my migraines, is a common treatment. Unfortunately I’m already at the highest dose of magnesium I appear to be able to tolerate without extreme nausea.

I’ve also been on the pill since I was 14 because I also suffer from unusually heavy and long periods so without the pill I bleed for 9 days every 28 with 5-6 of those so heavy I cannot leave the house. I also have endometriosis which means that every period is damaging me inside and potentially affecting my fertility.

I controlled all of these via the pill. I’d simply take it continually without the breaks until I had a break-through bleed. Granted I would often get the headaches regardless every month, but that depended on which pill I took.

So for me, the problem was when I hit 35 and was told that WHO regulations mean no more oral pill because I get migraines. I was devestated!

Luckily I found a great specialist who recommended a mirena coil – it’s a very low dose oestrogen only hormone delivered by a plastic coil. No daily pill popping and since I got it no periods at all and no menstrual migraines.

I would highly recommended it! In fact, I would leap off rooftops to recommend it!

Another thing, the problem with statistics is that they’re misleading. 8 times more likely… 8 times what? You need to find out what the base-line actually is, and you need to find it out for your own ethnicity, gender, circumstances before you know if this is a problem. If for example the baseline is 10% then 8 times is pretty ghastly, however, if the baseline is 0.01% then you’re still at 8 times 99.92% likely to NOT get one.

I have daily headaches and menstrual migraines. Well, actually mine come for about 3-4 days with my period and then about 3-4 days around ovulation. For me, it’s the dip in estrogen that happens at both those events.

I did the Nuvaring for awhile, which was great — it has very low dose hormones, so your risk for stroke etc. would be much lower than the conventional BCP. Plus, it’s inserted in your hoo haw, which is a much more effective delivery of hormones than an oral contraceptive, which passes thru your liver (and often loses a lot of its efficacy). You might give that a try!

As for herbal route, oh yes try that too! I highly recommend finding a reputable naturopath who also does acupuncture. Taht is what I’ve been doing for about 3 years now. It’s how I managed to conceive after 10 years of trying, kept my h/a somewhat under control without drugs during pregnancy, and is how I keep my h/a from destroying my life now. There are tons of herbs, and the best part of naturpathy or eastern medicine is that they are designed just for YOU — they will look at your body and your symptoms and find the best combo. Black cohosh, for example, really makes me miserable. Just 1 day on the stuff and I’m clutching my head in desperation. It didn’t take long for my naturopath and I to realize that anti-estrogenic herbs that often help migraineurs don’t help me! So we work on boosting my adrenals and hormones with other herbs, and that has worked great so far. No, I’m not pain free. I stil have headaches of one kind or another every day of my life. But I’m more in control of my h/a and rarely have the kind that have me in bed or vomitting now.

I have hormonal and tension headaches with migraine symptoms. They are considered to be “chronic daily headaches”. My head has been hurting at various levels pretty constantly for almost three years now. I don’t get intense migraines that knock me out completely, just constant pain. All of that said, I have decided to use the birth control pills. However, I use it to not only control my hormone levels, but also control the frequency of my period. Using birth control pills, I only get my period once every six months. (Studies show that a woman can go up to year without a period safely.) Additionally, I am on an estrogen patch. (My estrogen level was tested as below normal while on birth control pills….) As a result of both of doing these two things, my headache’s severity has lessened. However, it sounds like our headaches are different. That’s the thing about these headaches….they are so complicated and different for every single person….

Hi Kerrie,
First of all I am glad to hear that your headaches are settling down a bit..I remember what it was like to have the horrible hormone headache though..I do recommend the 90 pill to some migraineurs in our clinic but again I work with the patient’s GYN doc as everyone is different..it is a risk/benefit balancing thing.

I can tell you that most women respond to this and it does work out well for them and their migraines ..stats are very misleading and many times do not apply to clinical practice. I have 40-50 year old patients who were put on the pill for migraine.

What raises the risk of stroke of migraineurs is the increased frequency of uncontrolled headaches (more than 12 per year) not the fact that you just have migraine.

Other factors come into play also..family history of stroke, cholesterol levels, does the patient smoke, and believe it or not the NUMBER 1 risk is obesity.

Good luck..hope it works out for you!
Mary Kay Betz, MS RPA-C
Dent Headache Center

A hematologist can check your blood for clotting disorders (i.e, genetic gene variants/mutations).* A recent study linked clotting disorders and those with migraines (You wrote about it and linked to it on Sept. 16). The combo of the pill and a clotting disorder will raise the odds of a blood clot exponentionally.

For several years I have taken a low-dose birth control pill continuously to stop the dips in my estrogen levels, meaning I don’t take the placebo pills, take the regular pills continuously and never have a period. I used to have severe migraines during the week of my period — those are gone. I also watch my triggers which tend to be chocolate, nuts, MSG, nutrasweet and lack of sleep. I’m on a daily dose of 100 mg of Topamax and take Frova at the first sign of a headache. (more drugs than I would like, but manageable).

One light at the end of the tunnel — my OB/GYN said she never had a patient past menopause that continued having migraines. I’m hoping that’s true for me!

All of my migraines went away when I was pregnant, not just the menstrual ones. I felt completely normal. Before that, I had daily mild headache and averaged 6 days of severe migraines every month, most of those days around my period. After my daughter’s birth, I started having depo shots. They do prevent migraines. Obviously, I don’t have menstrual migraines and my other migraines are infrequent and mild. However, I have gained 30lbs on the shot…sigh. I am looking for another solution now. I was thinking I should be a surrogate mom and stay pregnant all the time. I handle pregnancy pretty well…

Actually, recent epidemiologic data on women with migraine show that there is independent risk of stroke due to migraine itself. Controlling other risk factors (blood pressure, cholesterol, smoking, weight) does not reduce the portion of risk that is due to migraine itself. While it is strongly suspected that there is a correlation between attack frequency and stroke risk, there is, as yet, no data from randomized controlled prospective trials to show that any specific number of headaches/month or per year is critical, or that any particular treatment is best.

In addition, it is strongly suspected that there is a subpopulation of migraineurs who are at greater risk of stroke than others (over and above those with aura vs those without) on the basis of “endothelial dysfunction”, which is very likely genetically determined.

Since I was 20 or so (I’m now 32) I’ve experienced menstrual migraines. I didn’t realize they were menstrual for years. (I never used tampons because I always was afraid I was getting TSS when a headache would come on!) When I was pregnant last year, a got two minor migraines during the 1st trimester and then none for the rest of the pregnancy. What heaven!!! When I started BC at 3 month post-partum they returned. I think mine are worsened by use of BC – even though their onset is prior to the off week.

From the posts here, I plan to investigate non-oral BC options that may reduce the migraines. I had no idea that there were other options. I do think mine are aggrevated by BC. Being on and off BC though my early 20s, I think that is why I never realized they were menstrual.

Hi Kerrie,
I have suffered with migraines all of my life but they always seem to get worse at the time of me period. I have tried everything but nothing ever seems to work. From hormone supplements to herbal medicines to general medications..I have just tried to live with it the best i can.

Thanks My friend,We are willing to look at this. Here is the sort of details which needs to be given rather than the accidental misinformation that’s in the other blogs. Appreciate your sharing this greatest doc.

everyone recommending Mirena beware!!!!!!!!! I was on the pill (cilest) for years and after I had my second child I started to get awful headaches that lasted for days so I stopped taking cilest and tried progesterone only pill which was just as bad. Then my doctor suggested Mirena and it sounded fab! Awful having it fitted and pain for days after . Then I had 8months of hell. I didn’t know it at the time but I was depressed. I have never felt so low in my life so I went to doctor thinking I had pnd in tears! Turns out Mirena can bring on depression even if you have no history of it. It was one of the worst times of my life and within a week of the Mirena being removed I felt better. Strangely my friend also went through the exact same thing unbeknownst to me at the time and my doctor actually explained that I was one of many women who had presented the same symptoms to him while on Mirena . Beware

I’m 26 years old, and have monthly migraines.
My migraines are not just hormonal.
its is also stress, coffee, missed meals, chedder cheese, certain shampoos and cosmetics, certain cleaining chemicals. i’ve learned to avoid things i know can worsen my migraine situation.
however, i want to mention MSM Forte, it is a herbal medication, consists of pure sulphate.
since i have migraines from the age of 6, then 12 then constant at age 16.
2 to 3 times a month. I tried several things, but the MSM took me from 2 -3 month to 2 YEAR -yes only 2 a year… wonderful is it not?
but, know i’m married got 2 children (youngest born last month) and i think of trying the Mirena, to make my life better with the awful heavy flow i have.
I’m back on my MSM pills – which i believe in TOTALLY… but i’m scared that the Mirena worsens my migraines. I’ve read SOOOOO many negative things about it- people who got it 10x worse.

however – to Kersti
you are the first person who i read about who praises this Mirena option.
i’m getting my Mirena tomorrow… i really hope it helps along with my herbal MSM pills.

i’m also a bit concern about the low sex drive and the depression stories i’ve read above here.
i guess i should try it – but someone who gets migraines i believe they can confirm with me…. it is a dead on fear to get it, or just to think about the fact that it can get worse 🙁